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Since March 2010 when the enrollment period opened up, much has been written, commented on and deciphered about the Affordable Healthcare Act. Still the confusion continues. The new law mandates that every individual have health insurance, but what about the cost? Is it free? Can I keep my existing doctor? What happens if I do not choose to have health insurance? Some of the changes include new rules in the insurance market to increase participation in health plans by expanding eligibility, offering protection against loss of eligibility, improving the quality of services and expanding choices for insurance coverage.

Prior to the new law going into effect, there were approximately 50MM uninsured Americans. The new law is expected to decrease that number by over 30MM people. The sources of coverage will also change due to the implementation of the Affordable Care Act. Previously, the major source of healthcare coverage in the United States came from employers. That will remain the same under the new law only at a lower overall percentage. The newly created insurance exchanges will handle 14% of healthcare coverage, gaining clients from the previously uninsured ranks. While some may choose to continue to proceed without health insurance there will be a penalty in the form of an additional tax starting at $95 per individual or 1% of their taxable income in year one. That penalty will increase in 2015 to $325 per person or 2% of taxable income and will increase once again in 2016.

To help translate and answer questions how ACA will affect individuals, employers, and insurance companies, Dr. Karen Minyard from the Georgia Health Policy Center joins us in the studio to share her in-depth knowledge of the new law. A nurse and hospital administrator for over 13 years, Dr. Minyard is the Director of the GHPC at Georgia State University and the Andrew Young School of Policy Studies. Listeners may find more information about the GHPC at www.gsu.edu/ghpc.

Dr. Karen Minyard

• PHD, Business Administration, Georgia State University
• MSN, Nursing Administration, Medical College of Georgia
• Bachelor of Science, Nursing, University of Virginia
• Board Member, National Network of Public Health Initiatives
• Board Member, Physician’s Innovation Network

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Hyperbaric medicine is recognized by most of us as the treatment of choice for deep dive sickness via decompression ( a process for removing excess nitrogen gas bubbles from the blood stream). Well-hyperbaric medicine has come a long way, is appropriate for many indications and can be the treatment of choice for conditions requiring hyperbaric oxygen therapy (HBOT) such carbon monoxide poisoning. Hyperbaric medicine has also provided great success in providing evidence-based, advanced wound care technology to improve chronic diabetic ulcers, radiation injuries, burns, and crushing injuries to tissue.

Treatments are provided in FDA approved, multiplace or monoplace hyperbaric chambers that delivers 100% oxygen in an environment that is pressurized 2-3 x normal atmospheric pressure. The theory is that with the additional oxygen and pressure, the oxygen transport cabability of the blood is greatly enhanced bringing an oxygen rich blood supply to promote faster healing in compromised tissues. The chamber also promotes vasoconstriction which can help in some conditions like burns. Patients are monitored by clinical staff throughout the treatment, which normally lasts about 2 hrs. Depending on the severity of the affected area, physicians prescribe and supervise a set number of treatments over time to obtain the healing results. There are not many contraindications for these treatments. Side effects are usually minor and ear or sinus pressure related, which often is naturally resolved within a few hours after treatment. Health insurance companies often cover the costs of the treatments for a variety of clinical indications.

For this segment, we are joined by guest, Charles Hall, BSN of Hyperbaric Physicians of GA (the largest hyperbaric medicine group in the Southeast) to provide the latest information on hyperbaric medicine. Listeners can find more information at www.hbomdga.com.

Dr. David Swhegman

• Medical Degree from The Ohio State University
• Residency completed in Emergency Medicine from OSU
• Former Asst. Professor of Emergency Medicine at Emory
• Chief Medical Director in private practice at Hyperbaric Physicians of Georgia
• Named 2011 “Top Doctor in Atlanta” by Atlanta Magazine

Charles Hall

• BSN from South University
• 8 yrs experience in surgical/cardiovascular intensive care
• Joined Hyperbaric Physicians of GA in 2010

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March is Colorectal Cancer Awareness month in the United States. Colon cancer is the third leading cause of cancer death in the US- and it is often preventable! The American Cancer Society estimates that approximately 140,000 people will be diagnosed with colorectal cancer this year and there will be about 50,000 deaths attributed to this disease. Yet almost 20 million Americans have not been screened (the current screening rate is 65.1%). The lifetime risk of developing colorectal cancer is 1:20.

Although it is possible for young people to get colon cancer, 9/10 people diagnosed are > 50 yrs old. A large percentage of colon cancers begin as polyps in the lining of the colon. Risk factors include: a history of polpys, a family history of colon cancer, inflammatory bowel diseases, smoking, and Crohn’s disease. Colonoscopy remains the “gold standard” for colorectal cancer screening, although there are blood tests and lower GI series that can also aid in the diagnosis. Early stage colorectal cancers can have as high as a 95% cure rate. Screening guidelines recommend starting regular screening at age 50 (unless there are risk factors that indicate earlier) and continuing until age 75. Signs and symptoms include: rectal bleeding, changes in bowel habits that last longer than a few days, abdominal pain, nausea, vomiting, fatigue and unintended weight loss. Treatments depend on the size and location of the tumors. Early stage disease can often be treated with surgical removal only. Late stage disease can include surgery, chemotherapy and at times, radiation.

For this segment, we have asked a local expert, Dr. Marc Sonenshine from Atlanta Gastroenterology Specialists to return during this month focused on screening to provide us with both basic information and updates on Colorectal Cancer. Listeners can find more information at www.atlantagastro.com.

Dr. Marc Sonenshine

• Board Certified in Internal Medicine and Gastroenterology
• MD from Medical College of GA; Residency completed at Johns Hopkins in Baltimore, Gastroenterology fellowship at Emory University
• MBA from Terry College of Business at University of GA
• Volunteers with Crohn’s and Colitis Foundation of America Camp Oasis for kids with IBD
• Special interest areas: inflammatory bowel disease, prevention of GI malignancy and management of chronic liver disease

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Excluding skin cancer, colorectal cancer is the third most common kind of cancer in the US and the third leading cancer-related cause of death in the US. Although the CDC reported in November of 2013 that 20 million Americans still have not completed a colon cancer screening test, the incidence of colon cancer has been steadily decreasing over the past 20 years. Possible reasons for this decline are improved screening finds pre-cancerous polyps early, treatments have improved and screening procedures have improved. It is expected that as the Affordable Care Act advances and more people have insurance (and this type of screening is covered) , that screening rates should improve. A procedure called a colonoscopy is the primary screening procedure (62%) for colon cancer screening. In addition, a colonoscopy has many other GI related indications, such as : bleeding, abdominal pain, polyp removal, unexplained weight loss and inflammatory bowel disease.

Until recently, many patients were fearful of going to get the colonscopy test completed due to discomfort during the procedure, an unwillingness to complete the required preparation or lack of insurance coverage. Beginning at age 50 (45 for African Americans), screening for colon cancer should begin if the pt. has no symptoms. A colonoscopy may be indicated earlier for patients with GI symptoms, a family history of colon cancer, or IBS. Now, in the news, are virtual colonoscopies- which require no sedation but do have additional radiation exposure risk.

For expertise in this segment, we have turned to a board certified GI specialist in Atlanta, Dr. Max Shapiro- who has a special interest in colon cancer screening . Dr. Shapiro is board certified in both internal medicine and gastroenterology/hepatology and is in private practice at Metro Atlanta Gastro at St. Joseph’s Hospital in Atlanta. Listeners can find more information at www.metroatlantagastro.com.

Dr. Max Shapiro

• Medical Degree from Tufts University in Boston, MA
• Internal Medicine fellowship completed at Emory University
• Fellowship in Gastroenterology and Hepatology from Georgetown in DC
• Board certified in Internal Medicine and Gastroenterology
• Private practice at Metro Atlanta Gastro with interest in colon cancer screening

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Urinary incontinence and an overactive bladder is not only a significant social and economic health problem, but it can be a “bother” for many women. There are large variations as the the degree of this problem and when to treat it. The prevalence of urinary incontinence in women peaks around menopause and some have estimated this health condition affects 3-17% of women. Urge incontinence is more likely to require treatment than stress incontinence. Causes for this condition are typically bladder or sphincter dysfunction or both.

Urodynamic testing are some procedures administered that can be administered in clinics, doctor’s office and at times the hospital. These focus on the bladder’s ability to hold urine and empty steadily and completely. Indications for urodynamic testing include: urine leakage, frequency of urination, painful urination, sudden strong urges to urinate, problems with starting a urine stream, problems with emptying the bladder completely and recurrent urinary tract infections. Testing procedures range from simple observation to sophisticated instruments and imaging. Types of urodynamic tests are: uroflowmetry, post void residual measurements, cystometric tests, leak point pressure, pressure flow studies, electromyography, and video urodynamic testing.

Tune in to this segment for more information about the “What, When and Why” of urodynamic testing as presented by local urogynecology expert, Dr. Jennifer Elliott, a local Atlanta gynecologist. Listeners can also obtain more information on www.whaatlanta.com.

Dr. Jennifer Elliott

• MD from LSU School of Medicine
• Completed residency at Atlanta Medical Center
• Board certified OB/GYN
• Named “Best Doc” by Lifestyle magazine
• In private practice at Women’s Health Associates

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Clinical research is a systematic approach to finding out what clinical approaches do and do not work and then using this gained knowledge in to advance and improve clinical decision making. There are many kinds of research, but in the US, about 59% of research focuses on drug research. At any one point in time the FDA has approximately 9-11 thousand clinical trials registered and these trials are seeking 2.8- 3 million subjects. Clinical trial investigative work is conducted in every disease state. Currently, a great deal of research is ongoing in cancer, cardiovascular, Neurology, and anti-infectives.

Bringing a drug to market in the US is a long (10-15 years) and expensive endeavor as about 90% of drug trials do not make it past the first phase of clinical trials. High quality results, timeliness and actionable evidence remain key indicators for a clinical trial. There are four phases of drug trials. Phase I involves safety testing in small numbers of patients. Phase II tests the drug in larger patient populations who have conditions or diseases the drug is meant to treat. Phase III is a pre-approval round where large populations of subjects with affiliated health issues test the new drug as compared to standard treatment. Roughly, 2/3 of Phase III clinical trials are approved by the FDA. Phase IV trials are post- FDA approval trials to explore additional adverse events, performance vs. competitive drugs and additional possible uses.

Patients often enroll in clinical trials with the belief that their experience may be of benefit to future patients. Clinical trial management is highly regulated with involvement and monitoring from many agencies. Informed consent is required. Most consumers and clinicians think of clinical trial research as being performed in large academic medical centers. However, there are many community level models that are available to extend participation and the quality of the research across populations as we are finding that drug response may vary more than previously expected due to each person’s unique pharmacogenomics.

Tune in to this segment to learn about clinical trial research in general and for more information about unique and highly successful community based models of research occurring in GA and the Southeast. Dr. Jeff Kingsley, a clinical research veteran at the national level and his associates will lend their expertise in the field of drug clinical trial research. Listeners can also obtain more information on www.serrg.com and the FDA’s research site at www.clinicaltrials.gov.

Dr. Jeff Kingsley

• Medical training at Philadelphia College of Osteopathic Medicine
• Completed residency in Family Practice at Columbus Regional Medical Ctr
• MBA from Emory University
• CEO/Founder of Southeastern Regional Research Group

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The male role in contraception has been thought of as relatively simple, when in fact, it is actually quite complicated. The Mayo Clinic estimates that 15% of couples are infertile (frequent , unprotected sex of childbearing age with no pregnancy in one year). Research estimates show that 7.5-10% of all males of reproductive age are infertile. Male infertility is a major cause of no conception in 50% of childless couples. Male infertility can be defined as abnormalities in sperm production, maturity or delivery that impedes the establishment of pregnancy.

The male reproductive cycle involves testosterone secretion that is the common link between the pituitary gland and the testes. To achieve a pregnancy from the male component the following is needed: 1) healthy sperm 2) enough sperm is carried to the semen 3) the sperm is correctly shaped for motility and 4) no ejaculation problems. Causes for male infertility include varioceles (swelling of veins that drain the testes-42%), obstruction, infection, chromosome abnormalities, hormone imbalances, tumors, ejaculation problems, anti-sperm antibodies, sperm duct defects, some chronic diseases, environmental causes (exposures) and lifestyle causes (weight, stress, smoking and drug use). Male infertility evaluation often includes a semen analysis, an extensive medical history, a physical exam, lab testing and ultrasound examination.

Treatment of male infertility usually focuses on correction of the underlying problem or using treatments to help with the infertility. Possible treatments include: surgery, medications and assisted reproductive technologies such as sperm retrieval, sperm donation and cryopreservation. The process of identifying and treating male infertility can be stressful for the individual and couple. Costs can be high and this treatment is typically not covered by health insurance. The outcome is often unknown for some time period and stress can be high. There are many coping strategies and support groups for psychosocial support.

In this segment, Dr. Michael Witt, a board certified urologist and male infertility specialist (one of the few in the southeast) will discuss the a general overview of male infertility. Listeners can visit: www.rba-online.com and www.resolve.org for more information.

Dr. Michael Witt

• MD obtained from Oregon Health Science University
• Completed residency in urology at Boston University Hospital
• Fellowship in male infertility completed at Baylor College of Medicine in TX
• Board-certified in urology
• Featured on CNN, The Learning Channel, named one of Atlanta’s Top Doctors
• Now in private practice at Reproductive Biology Associates in Atlanta